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Perinatal prevention of bronchopulmonary dysplasia
1Division of Asthma, Allergy and Lung Biology, School of Medicine, King's College London, London, UK. anne.greenough@kcl.ac.uk
Insights
Caffeine administration can reduce the incidence of bronchopulmonary dysplasia (BPD) in premature infants without adverse effects. This finding offers a promising strategy for improving outcomes in very premature births.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a common complication in very premature infants, characterized by oxygen dependency for at least 28 days.
- While lung function may improve, airflow abnormalities and respiratory symptoms can persist into adolescence and adulthood.
- Previous preventative strategies have shown mixed results, with some lacking a favorable risk-benefit ratio (e.g., postnatal corticosteroids).
Purpose of the Study:
- To investigate effective and safe strategies for reducing the incidence of bronchopulmonary dysplasia (BPD) in very premature infants.
- To evaluate the impact of caffeine administration on BPD rates and associated adverse effects.
- To explore promising approaches like avoiding high oxygen concentrations during resuscitation.
Main Methods:
- Review of clinical trials and studies investigating preventative therapies for BPD.
- Analysis of data from a major trial demonstrating the effect of caffeine administration on BPD incidence.
- Assessment of the risk-benefit profiles of various interventions, including antenatal and postnatal therapies.
Main Results:
- Caffeine administration has been shown in a major trial to reduce BPD incidence without adverse effects.
- Antenatal corticosteroids and postnatal surfactant improve infant outcomes but do not significantly impact BPD rates, possibly due to increased survival of extremely premature infants.
- Avoiding high oxygen concentrations during resuscitation emerges as a promising strategy for BPD reduction.
Conclusions:
- Caffeine administration represents a beneficial and safe strategy for reducing bronchopulmonary dysplasia in very premature infants.
- Further research and implementation of strategies like controlled oxygen use at resuscitation are warranted.
- Optimizing preventative care is crucial for improving long-term respiratory health in survivors of extreme prematurity.
Abstract:
Bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the fi rst 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airflow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefit ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in significant benefits to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.
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